title: Serial transverse enteroplasty allows children with short bowel to wean from parenteral nutrition.
abstract: OBJECTIVE
  To analyze the effects of serial transverse enteroplasty (STEP) on parenteral and enteral calories in children with short bowel syndrome, and examine short- and long-term complications.
  
  
  METHODS
  A retrospective analysis of prospectively-collected data from a large single center cohort of patients undergoing STEP procedure was analyzed. Baseline demographic and clinical information, operative data, and short- and long-term complications were recorded. Detailed growth and nutritional data were obtained for 6 months prior and 12 months following STEP procedure.
  
  
  RESULTS
  Sixty-eight procedures were performed in 51 patients over a 68-month period. Median bowel length at first STEP was 51 cm with a median length gain of 54%. Repeat STEP patients had longer initial length (77 cm) and reduced length gain (20%). Operative times and blood loss were low, with few complications. Parenteral calorie requirement was stable or rising for 6 months prior to STEP, but decreased to median <20 kCal/kg/d at 1 year postop. Longer length gains were associated with higher risk of stricture formation. Seven children were transplanted, and 60% of nontransplanted children were enterally independent, with the remainder making ongoing progress; 48/51 children are alive at a median of 39 months follow-up.
  
  
  CONCLUSIONS
  STEP is shown to be safe, well tolerated, and to have definitive benefit in reducing parenteral calorie requirements over the first year following the procedure. It has an important role in achieving enteral independence in children with short bowel syndrome.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE. Electronic address: dmercer@unmc.edu.
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
authors.affiliation: Department of Clinical Nutrition, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Brandy D
authors.initials: BD
authors.lastname: Hobson
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Brandi K
authors.initials: BK
authors.lastname: Gerhardt
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Grant
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Vargas
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Alan N
authors.initials: AN
authors.lastname: Langnas
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Ruben E
authors.initials: RE
authors.lastname: Quiros-Tejeira
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014886:Weaning
keywords: IRP; IV; Intestinal rehabilitation program; Intravenous; NEC; Necrotizing enterocolitis; PN; Parenteral nutrition; STEP; Serial transverse enteroplasty; TPN; Total parenteral nutrition